Unit 2 (Pelvic Girdle & Proximal Femur)
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. What would you like to do?
What serves as the base of the trunk of the body?
What forms the connection between the vertebral column and the lower limbs?
What bones make up the pelvis?
- two hip bones
what bones make up the pelvic girdle?
two hip bones
Give two alternate names for the hip bone:
- ossa coxae
- innominate bone
Name the three divisions of the hip bone:
What bones do we "sit on"?
What bone is inferior and anterior to the acetabulum?
What bone is inferior and posterior to the acetabulum?
At what vertebral level is the ASIS located?
At what vertebral level is the iliac crest located?
What is the name of the "wing" of the ilium?
How are the margins of the ala located in relation to each other?
the lateral margin is anterior to the medial margin
What part of the pelvis makes up the upper 2/5 of the acetabulum?
Of the pubis, is the superior ramus or the inferior ramus more anterior?
the superior ramus
- A. Posterior Superior Iliac Spine (PSIS)
- B. Posterior Inferior Iliac Spine
- C. Greater Sciatic Notch
- D. Ischial Spine
- E. Lesser Sciatic Notch
- F. Ischial Tuberosity
- G. Ischium
- H. Ischial Ramus
- I. Ala of Ilium
- J. Iliac Crest
- K. Anterior Superior Iliac Spine (ASIS)
- L. Anterior Inferior Iliac Spine
- M. Body of Ilium
- N. Acetabulum
- O. Peclineal Line
- P. Superior Ramus of the Pubis
- Q. Obturator Foramen
- R. Pubis
- S. Inferior Ramus of the Pubis
- A. Iliac Crest
- B. Anterior Superior Iliac Spine (ASIS)
- C. Anterior Inferior Iliac Spine
- D. Acetabulum
- E. Ischium
- F. Obturator Foramen
- G. Ala of Ilium
- H. Auricular Surface
- I. Posterior Superior Iliac Spine
- J. Posterior Inferior Iliac Spine
- K. Ischial Spine
- L. Body of Pubis
- M. Peclineal Line
- N. Superior Ramus of Pubis
- O. Inferior Ramus of Pubis
- A. iliac crest
- B. ASIS
- C. ischial spine
- D. greater trochanter
- E. lesser trochanter
- F. inferior ramus of pubis
- G. pubic symphysis
- H. obturator foramen
- I. ischium
- J. acetabulum
- K. sacrum
- L. sacroiliac (SI) joints
- M. Ala of ilium
What is the small indention on the head of the femur that is a ligament attachment site?
What is the part of the femur that runs between the greater and lesser trochanters, anteriorly?
What is the part of the femur that runs between the greater and lesser trochanters, posteriorly?
Describe how the width of the pelvis influences the angle of the neck of the femur:
- a wide pelvis will decrease the angle of the femoral neck
- a narrow pelvis will increase the angle of the femoral neck
Describe how the width of the pelvis influences the longitudinal angle of the femur:
- a wide pelvis will mean more longitudinal angulation of the femur
- a narrow pelvis will mean less longitudinal angulation of the femur
At the neck, the femur projects _______ anteriorly and _______ superiorly. The longitudinal plane is angled ________________.
- 10° from vertical
What type of joint is the hip joint?
- spheroidal (ball & socket)
What type of joint is the SI joint?
- gliding/plane (irregular)
What is the name of the medial surface of the ilium which articulates with the sacrum to form the SI joint?
What is the slight ridge of bone that runs medially and anteriorly forming the brim of the pelvis?
What is the degree of angulation of the SI joints?
25-30° to the midsagittal plane
What is the most anterior joint of the the pelvis?
the pubic symphysis
What type of joint is the pubic symphysis?
Describe the differences between the male and female pelvis:
- the female pelvis is wider, more flared, with the fossa being more shallow
- the female bony structures appear lighter and thinner
- the female pubic arch is an obtuse angle (>90°)
- the male pubic arch is an acute angle (<90°)
- the female inlet is more oval shaped & male is more rounded
What follows the medial shape of the ilium around to the superior border of the pubis and to the top of the sacrum?
the pelvic brim
What is the name for the top aspect of the sacrum?
the sacral promontory
The region above the pelvic brim is the _________ and the region below the pelvic brim is the __________.
- false (greater) pelvis
- true (lesser) pelvis
The brim (from the sacral promontory to the superior margin of the pubic symphysis) forms the ________, while a measurement from the tip of the coccyx to the inferior margin of the pubic symphysis forms the ___________.
- superior aperture (inlet)
- inferior aperture (outlet)
The region between the inlet and the outlet is the __________.
How do you find the location of the femoral head?
1 1/2" distal to the midpoint of an imaginary line from the ASIS to the superior margin of the pubic symphysis
How do you find the location of the femoral neck?
2 1/2" distal to the midpoint of an imaginary line from the ASIS to the superior margin of the pubic symphysis
When localizing the hip joint, what is palpated?
only the ASIS
How do you get the proximal femur and hip joint to be projected in a true AP projection?
internally rotate the leg 15-20°
what are the two most common fracture sites, concerning the hip?
- the femoral neck
- the intertrochanteric crest
What is a clinical sign of a fractured hip (at femoral neck)?
external rotation of the involved foot so that it's at a 90° angle
Where should the shield be placed for a male, for pelvis?
top of shield at inferior margin of pubic symphysis
Where should the shield be placed for a female, for pelvis?
- only if it will not cover pertinent anatomy
- Prone is an option to reduce exposure, sometimes
- A. greater trochanter
- B. neck of femur
- C. head of femur
- D. lesser trochanter
- E. body/shaft of femur
- F. fovea capitis
- G. intertrochanteric crest
What cassette size and orientation do you use for pelvis projections?
Where do you center for an AP pelvis?
midway between ASIS and pubic symphysis (leg crease)
- AP Hip
- blah blah. you know this one.
What is the easiest way to tell on a hip/pelvis radiograph if a positioning error is present where legs/feet were not rotated in 15-20°?
the lesser trochanters are easily seen medially
What is the method used for an AP oblique pelvis?
- Modified Cleaves Method
- (bilateral "frog leg")
For the Modified Cleaves Method, by how much should the femurs be angled?
Where do you center for the Modified Cleaves Method of the pelvis?
3" below the ASIS, on the mid-sagittal plane
How should the greater trochanters appear for a Modified Cleaves pelvis?
overlapping the neck of the femur
What cassette size and orientation is used for hip projections?
10x12LW (to part)
For the Unilateral Frog Leg (Modified Cleaves), what should be centered to the midline of the grid?
the ASIS of the affected side
- Modified Cleaves Method (AP oblique)
- no rotation (symmetrical appearance)
- lesser trochanter on medial side
- femoral neck without superimposition by greater trochanter
For the lateral hip projection, the ___________ Method uses a 20-25° cephalic CR, and the ___________ Method uses a perpendicular CR.
What is the angulation used for the Hickey method for a lateral hip projection?
What positioning change is made if moving from a unilateral frog leg to a lauenstein/hickey method?
- for the unilateral frog, the thigh is abducted 45° laterally
- for both the hickey and lauenstein methods, the leg of the affected side is flat on the table (bent at knee) with unaffected hip elevated
What pelvis/hip projection should never be done on a suspected fracture?
A Frog Leg position
When viewing radiographs of a Lauenstein and a Hickey projection, what is a major noted difference?
- lauenstein - greater trochanter overlaps femoral neck
- hickey - greater trochanter does not overlap femoral neck
Between Lauenstein and Hickey, which is the better view of the neck of the femur?
- Lauenstein Method (lateral)
- hip joint centered
- femoral neck overlapped by greater trochanter
- Hickey Method (lateral)
- hip joint centered
- femoral neck free of superimposition
- Axiolateral inferiosuperior projection (used for trauma hip)
- Danelius-Miller Method
- no overlap of neck and greater trochanter
- small amount of lesser trochanter, posteriorly
- small amount of greater trochanter, anterior and posterior
- ischial tuberosity below femoral head
For the Danelius-Miller Method, explain the alignment of the tube, part, and IR:
- tube is perpendicular to both the neck of the femur and the IR
- neck of femur is parallel to the IR
- AP axial "outlet" projection
- Taylor Method
- pubic & ishial bones magnified
- pubic bones superimposed over sacrum & coccyx
- pubic & ishial rami near center
What is specific to the Taylor Method, when taking an AP projection of the pelvis?
- for males: angle CR 20-35° cephalic
- for females: angle CR 30-45° cephalic
- (AP axial "outlet" projection, mostly for trauma pts)
- Judet Method (AP Oblique)
- an RPO or LPO position (45° from table)
- internal oblique - suspected fx of iliopubic column (anterior) and posterior rim of acetabulum; affected hip UP
- external oblique - suspected fx of ilioischial column (posterior) and anterior rim of acetabulum; affected hip DOWN
- Clements-Nakayama Modification Method
- modified axiolateral projection
- for when unaffected leg cannot be raised to complete a danelius-miller method
- 15° posterior angulation of CR
Which method would you most likely use to image a suspected fractured hip?
- AP, as is
- cross table lateral (Danelius-Miller Method)
Which two bones form the obturator foramen?
Where's the CR for a unilateral hip?
the neck of the femur
What method is being used for an axiolateral projection of the hip?
Greater trochanters can be used as a palpable landmark for the same plane as what other landmark?
pubic bone/pubic symphysis
For positioning, on an AP pelvis, if the left ilium is flared and the right obturator foramen is open, in which direction is the patient rotated?
- to the left
- (the side of pelvis closer to IR, ilium flared, foramen closed)
- (elevated side, ilium foreshortened, foramen open)
What methods would the CR enter the medial aspect of the proximal femur?
- modified cleaves
- (all frog legs, all laterals)
What would you like to do?
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